title: Tumor growth pattern as predictor of colorectal liver metastasis recurrence.
abstract: BACKGROUND
  Surgical resection is the gold standard therapy for the treatment of colorectal liver metastases (CRM). The aim of this study was to investigate the impact of tumor growth patterns on disease recurrence.
  
  
  METHODS
  We enrolled 91 patients who underwent CRM resection. Pathological specimens were prospectively evaluated, with particular attention given to tumor growth patterns (infiltrative vs pushing).
  
  
  RESULTS
  Tumor recurrence was observed in 65 patients (71.4%). According to multivariate analysis, 3 or more lesions (P = .05) and the infiltrative tumor margin type (P = .05) were unique independent risk factors for recurrence. Patients with infiltrative margins had a 5-year disease-free survival rate significantly inferior to patients with pushing margins (20.2% vs 40.5%, P = .05).
  
  
  CONCLUSIONS
  CRM patients with pushing margins presented superior disease-free survival rates compared with patients with infiltrative margins. Thus, the adoption of the margin pattern can represent a tool for improved selection of patients for adjuvant treatment.
authors.affiliation: Department of Gastroenterology, University of São Paulo Medical School, Hospital das Clínicas, Rua Dr Enéas de Carvalho Aguiar, 255, 9° Andar-sala 9113/9114, CEP 05403-900, São Paulo, Brazil. Electronic address: rsnpinheiro@gmail.com.
authors.forename: Rafael S
authors.initials: RS
authors.lastname: Pinheiro
authors.affiliation: Department of Gastroenterology, University of São Paulo Medical School, Hospital das Clínicas, Rua Dr Enéas de Carvalho Aguiar, 255, 9° Andar-sala 9113/9114, CEP 05403-900, São Paulo, Brazil.
authors.forename: Paulo
authors.initials: P
authors.lastname: Herman
authors.affiliation: Department of Gastroenterology, University of São Paulo Medical School, Hospital das Clínicas, Rua Dr Enéas de Carvalho Aguiar, 255, 9° Andar-sala 9113/9114, CEP 05403-900, São Paulo, Brazil.
authors.forename: Renato M
authors.initials: RM
authors.lastname: Lupinacci
authors.affiliation: Department of General Surgery and Organ Transplantation, Sapienza University of Rome, Umberto I Policlinic of Rome, Rome, Italy.
authors.forename: Quirino
authors.initials: Q
authors.lastname: Lai
authors.affiliation: Department of Pathology, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Evandro S
authors.initials: ES
authors.lastname: Mello
authors.affiliation: Department of Gastroenterology, University of São Paulo Medical School, Hospital das Clínicas, Rua Dr Enéas de Carvalho Aguiar, 255, 9° Andar-sala 9113/9114, CEP 05403-900, São Paulo, Brazil.
authors.forename: Fabricio F
authors.initials: FF
authors.lastname: Coelho
authors.affiliation: Department of Gastroenterology, University of São Paulo Medical School, Hospital das Clínicas, Rua Dr Enéas de Carvalho Aguiar, 255, 9° Andar-sala 9113/9114, CEP 05403-900, São Paulo, Brazil.
authors.forename: Marcos V
authors.initials: MV
authors.lastname: Perini
authors.affiliation: Department of Gastroenterology, University of São Paulo Medical School, Hospital das Clínicas, Rua Dr Enéas de Carvalho Aguiar, 255, 9° Andar-sala 9113/9114, CEP 05403-900, São Paulo, Brazil.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Pugliese
authors.affiliation: Department of Gastroenterology, University of São Paulo Medical School, Hospital das Clínicas, Rua Dr Enéas de Carvalho Aguiar, 255, 9° Andar-sala 9113/9114, CEP 05403-900, São Paulo, Brazil.
authors.forename: Wellington
authors.initials: W
authors.lastname: Andraus
authors.affiliation: Department of Gastroenterology, University of São Paulo Medical School, Hospital das Clínicas, Rua Dr Enéas de Carvalho Aguiar, 255, 9° Andar-sala 9113/9114, CEP 05403-900, São Paulo, Brazil.
authors.forename: Ivan
authors.initials: I
authors.lastname: Cecconello
authors.affiliation: Department of Gastroenterology, University of São Paulo Medical School, Hospital das Clínicas, Rua Dr Enéas de Carvalho Aguiar, 255, 9° Andar-sala 9113/9114, CEP 05403-900, São Paulo, Brazil.
authors.forename: Luiz Carneiro
authors.initials: LC
authors.lastname: D'Albuquerque
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D015179:Colorectal Neoplasms / Q000473:pathology*; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology*; D009367:Neoplasm Staging / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends
keywords: Colorectal metastasis; Colorectal neoplasms; Hepatectomy; Pathology; Recurrence; surgical